How would you escalate therapy beyond MMF in a patient with rapidly progressive SSc-ILD?

These are very challenging patients. They are often young African American, males with a positive Scl 70 who may have a significant restrictive disease at the time of diagnosis. MMF seems to be the best approach but when there is the progression I do strongly consider adding nintedanib, and definite...

I might use rituximab before nintedanib because of superior trial results.